Too bad I didn’t have a camera on my microscope (slit lamp) to capture a hole inside the eye. But if I could, it would look like something in the picture above. That is a retinal hole. Today, one of my patients came in with long standing flashes of light, and he has a couple of these holes in one of his eyes.

What is the retina?

The retina is the internal layer of the eyeballs that have the power houses (rods and cones) to capture the light and transfer them to energy, to send signals through the optic nerve to the back of the brain (visual cortex).

What is a retinal hole?

A retinal hole, tear, or detachment can occur at the retina by chance, by age, from injury, or from a highly myopic eye (people with -5.00 or higher in Rx). It can happen near the macula, which would affect the central vision, or in the peripheral, which leads to blind spots in the side visual field. But wherever there is a hole/tear or detachment, there is no light captured in the area, hence, loss of vision in that area.

What to do with a retinal hole?

A retinal hole needs to be treated as soon as possible. If it is a tear or a detachement, it needs to be lasered/operated on within 12-48 hour. Especially when a tear could stretch into a detachment, affecting larger areas of the retina. Otherwise, there would be loss of vision with holes and tears, leading to total blindness in detachements.

How do I know if I have one?

Most of the time, there would be flashes of light. If the holes are far into the peripheral, or smaller, there may be no symptoms. When flashes of light (lightning streak originated from the eye) or sudden floaters (mobile spots of light in the line of vision) occur, see an optometrist as soon as possible. She/he would dilate your pupil and look inside to see if there are any holes/tears. If found, urgent referral to the ophthalmologist is required to confine the hole/tears, to prevent it from turning into a full detachment. Or if a full detachment is found, Cryopexy (induce a chorioretinal scar to create bondage) can be done. These are outpatient (one day or less) procedures, hospitalization overnight is not necessary.

When there are no symptoms, retinal holes/tears may still occur. Since there are no pain receptors at the back of the eyes, it is important for individuals to have routine eye exams to invest in their eye health. We all have only two eyes, and they are irreplaceable.